Archive for Phobias

Paruresis Treatment – Pee Phobia

Phobiason November 20th, 2014No Comments

By Jorg Thonnissen – Psychologist and Hypnotherapist in Perth

These days I deal quite frequently with clients who work in the mining industry and as a consequence of their employment condition have to provide urine samples to show that they are drug free. It isn’t uncommon to find that peeing into a cup while being observed can create a condition called paruresis.

In other words, that person finds it difficult or impossible to urinate when other people are around – something that then sets off a whole rafter of psychological issues which can be likened to performance anxiety. This challenging condition is also known by a number of other names such as ‘avoidant paruresis’ , ‘shy bladder syndrome’, ‘psychogenic urinary retention’ or ‘pee-phobia’.Paruresis is related to social phobia and it is ranking in severity second to the fear of public speaking (Loriente, 2007; Soifer, Zgourides, Himle, & Pickerling, 2001).

It affects men and women from all walks of life. On the lower scale, paruresis is an event that occurs now and then. For instance, one may find that while in a public urinal one is unable to urinate when flanked by other men. In more severe cases, a person suffering from paruresis can only urinate when complete privacy is ensured.

From a psychological perspective, a person with paruresis could be of an overly sensitive, shy, conscientious personality and thus may be fearful of being judged or criticised by others or just simply crumbles under the enormous pressure that builds up when they are expected to do it ‘there and then’.

Paruresis as such is not a physical condition hence an urologist or GP can do little because nothing is wrong with the person’s urinary tract. It is all about relaxing the urinary sphincter so that the urine can flow from the bladder down the urethra but because anxiety overstimulates the person’s nervous system and literally ‘clamps’ the sphincter shut. Thus the cycle begins whereby the failure to urinate then increases the anxiety which makes matters worse.

This issue can be addressed with the help of relaxation strategies, hypnotherapy and CBT in order to help reduce anxiety. In addition, if the experienced difficulties are threatening my clients’ job security I usually also write a letter that can be presented to the employer or staff doing the drug and alcohol testing ensuring that the client gets the right amount of ‘space’ or suggesting that other methods should be employed. Combined, this usually does the ‘trick’.


Loriente, Z. C. (2007). [What is paruresis or shy bladder syndrome? A transdisciplinary research]. Actas urologicas espanolas, 31(4), 328-337.

Soifer, S., Zgourides, G. D., Himle, J., & Pickerling, N. L. (2001). Shy bladder syndrome: Your step-by-step guide to overcoming paruresis: New Harbinger Pubns Inc.